Malaria epidemiology and key control interventions in the Democratic Republic of Congo INAUGURALDISSERTATION zur Erlangung der Würde eines Doktors der Philosophie vorgelegt der Philosophisch-Naturwissenschaftlichen Fakultät der Universität Basel von Henry Maggi Tabala Ntuku aus Kinshasa, (Demokratische Republik Kongo) Basel, 2016 Originaldokument gespeichert auf dem Dokumentenserver der Universität Basel edoc.unibas.ch Genehmigt von der Philosophisch-Naturwissenschaftlichen Fakultät auf Antrag von Prof. Dr. Christian Lengeler und Prof. Dr. Immo Kleinschmidt. Basel, 20.09.2016 Prof. Dr. Jörg Schibler The Dean of Faculty ii To the Almighty Lord To my parents To my lovely wife Lisa and my adorable sons Dylan David and Allan Daniel iii Table of contents List of figures……………………………………………………………...…………………vii List of tables…………………………………………………………………..….………..….ix List of acronyms……………………………………………..…..…….…….…..…...……....xi Acknowledgements…………………………………..………………….………..…………xiii Summary……………………………………………………………………………………..xv Résumé……………………………………………………….…….………………………xviii 1 Introduction ............................................................................................................ 1 1.1 Malaria parasite and disease ..................................................................................... 1 1.2 Global malaria distribution, burden and population at risk ........................................ 2 1.3 Malaria vector .......................................................................................................... 3 1.4 Malaria prevention ................................................................................................... 3 1.5 LLIN distribution channels ....................................................................................... 4 1.6 Malaria treatment: severe malaria ............................................................................. 5 1.7 The Democratic Republic of Congo: administrative and health organisation ............ 6 1.8 Epidemiology of malaria in the Democratic Republic of Congo ................................ 8 1.9 Malaria control in the DRC..................................................................................... 11 2 Goal and objectives of the present thesis ............................................................. 13 2.1 Goal ....................................................................................................................... 13 2.2 Objectives .............................................................................................................. 13 3 A comprehensive malaria risk map in Kinshasa, Democratic Republic of Congo14 3.1. Abstract .................................................................................................................. 15 3.2. Background ............................................................................................................ 17 3.3. Method ................................................................................................................... 18 3.4. Results.................................................................................................................... 26 3.5. Discussion .............................................................................................................. 41 iv 3.6. Conclusions ............................................................................................................ 43 4. Identifying risk factors for Plasmodium infection and anaemia in Kinshasa, Democratic Republic of Congo ............................................................................ 44 4.1. Abstract .................................................................................................................. 45 4.2. Background ............................................................................................................ 47 4.3. Method ................................................................................................................... 48 4.4. Results.................................................................................................................... 50 4.5. Discussion .............................................................................................................. 58 4.6. Conclusions ............................................................................................................ 60 5. An operational comparative study of quinine and artesunate for the treatment of severe malaria in hospitals and health centres in the Democratic Republic of Congo: The MATIAS study ................................................................................. 61 5.1. Abstract .................................................................................................................. 62 5.2. Background ............................................................................................................ 63 5.3. Methods ................................................................................................................. 64 5.4. Results.................................................................................................................... 71 5.5. Discussion .............................................................................................................. 77 5.6. Conclusions ............................................................................................................ 80 6. Feasibility and acceptability of injectable artesunate for the treatment of severe malaria in the Democratic Republic of Congo .................................................... 81 6.1. Abstract .................................................................................................................. 82 6.2. Background ............................................................................................................ 83 6.3. Methods ................................................................................................................. 84 6.4. Results.................................................................................................................... 88 6.5. Discussion .............................................................................................................. 94 6.6. Conclusions ............................................................................................................ 96 v 7. Long-Lasting Insecticidal Net (LLIN) ownership, use and cost of implementation after a mass distribution campaign in Kasaï Occidental Province, Democratic Republic of Congo ............................................................ 97 7.1. Abstract .................................................................................................................. 98 7.2. Background .......................................................................................................... 100 7.3. Methods ............................................................................................................... 101 7.4. Results.................................................................................................................. 106 7.5. Discussion ............................................................................................................ 121 7.6. Conclusions .......................................................................................................... 124 8. Malaria morbidity in the Democratic Republic of Congo from 2010 to 2014: What is really captured by the surveillance system?. ....................................... 125 8.1. Abstract ................................................................................................................ 126 8.2. Background .......................................................................................................... 127 8.3. Methods ............................................................................................................... 129 8.4. Results.................................................................................................................. 132 8.5. Discussion ............................................................................................................ 140 8.6. Conclusions .......................................................................................................... 143 9. General discussion and conclusions ................................................................... 144 9.1. Implications for malaria control in Kinshasa ......................................................... 145 9.2. Implications for the implementation of injectable artesunate ................................. 146 9.3. Implications for LLIN distributions ...................................................................... 148 9.4. Implications for malaria surveillance .................................................................... 149 9.5. Overall conclusions and outlook ........................................................................... 150 10. References ........................................................................................................... 152 vi List of Figures Figure 1-1: Administrative map of the Democratic Republic of Congo showing the 11 old provinces and the 26 new provinces ...................................................................................... 8 Figure 3-1: Plasmodium falciparum malaria prevalence (RDT positivity) by age group for the health zones of Selembao and Ngiri Ngiri ..........................................................................